Recurrent Low-Grade Cerebral Astrocytoma
Recurrent High-Grade Cerebral Astrocytoma

Recurrent Low-Grade Cerebral Astrocytoma

Low-grade glioma may recur many years after initial treatment.[1] Disease typically recurs at the primary tumor site. Multifocal or disseminated disease is rare but can occur.[2] Most children whose low-grade fibrillary astrocytomas recur will harbor low-grade lesions; however, malignant transformation is possible.[3] Biopsy or surgical resection may be necessary for confirmation of relapse because other entities, such as secondary tumor and radiation-related brain necrosis, may be clinically indistinguishable from tumor recurrence. The need for further surgical intervention must be individualized on the basis of the initial tumor type, the length of time between initial treatment and the reappearance of the mass lesion, and the clinical status of the child.

An individual plan needs to be tailored on the basis of patient age, tumor location, and prior treatment. Drug combinations, such as carboplatin and vincristine, may be useful at the time of recurrence for children with low-grade gliomas.[4,5] For those children with recurrent low-grade glioma for whom radiation therapy is indicated, conformal radiotherapeutic approaches appear effective and offer the potential for reducing the acute and long-term toxicities associated with this modality.[6,7]

Most patients with high-grade gliomas will eventually have tumor recurrence, usually within 3 years of original diagnosis but perhaps many years after initial treatment. Disease may recur at the primary tumor site, at the margin of the resection/radiation bed, or at noncontiguous central nervous system sites. Systemic relapse is rare but may occur. At the time of recurrence, a complete evaluation for extent of relapse is indicated for all malignant tumors. Biopsy or surgical resection may be necessary for confirmation of relapse because other entities, such as secondary tumor and treatment-related brain necrosis, may be clinically indistinguishable from tumor recurrence. The need for surgical intervention must be individualized on the basis of the initial tumor type, the length of time between initial treatment and the reappearance of the mass lesion, and the clinical picture.

Patients for whom initial treatment fails may benefit from additional treatment.[8] High-dose chemotherapy with hematopoietic stem cell transplant may be effective in a subset of patients with minimal residual disease at time of treatment.[9,10] Such patients should also be considered for entry into trials of novel therapeutic approaches. Information about ongoing clinical trials is available from the NCI Web site.

References

1. Leibel SA, Sheline GE, Wara WM, et al.: The role of radiation therapy in the treatment of astrocytomas. Cancer 35 (6): 1551-7, 1975.  [PUBMED Abstract]
   
   
2. Perilongo G, Carollo C, Salviati L, et al.: Diencephalic syndrome and disseminated juvenile pilocytic astrocytomas of the hypothalamic-optic chiasm region. Cancer 80 (1): 142-6, 1997.  [PUBMED Abstract]
   
   
3. Giannini C, Scheithauer BW: Classification and grading of low-grade astrocytic tumors in children. Brain Pathol 7 (2): 785-98, 1997.  [PUBMED Abstract]
   
   
4. Packer RJ, Lange B, Ater J, et al.: Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol 11 (5): 850-6, 1993.  [PUBMED Abstract]
   
   
5. Gnekow AK, Kortmann RD, Pietsch T, et al.: Low grade chiasmatic-hypothalamic glioma-carboplatin and vincristin chemotherapy effectively defers radiotherapy within a comprehensive treatment strategy -- report from the multicenter treatment study for children and adolescents with a low grade glioma -- HIT-LGG 1996 -- of the Society of Pediatric Oncology and Hematology (GPOH). Klin Padiatr 216 (6): 331-42, 2004 Nov-Dec.  [PUBMED Abstract]
   
   
6. Merchant TE, Zhu Y, Thompson SJ, et al.: Preliminary results from a Phase II trail of conformal radiation therapy for pediatric patients with localised low-grade astrocytoma and ependymoma. Int J Radiat Oncol Biol Phys 52 (2): 325-32, 2002.  [PUBMED Abstract]
   
   
7. Marcus KJ, Goumnerova L, Billett AL, et al.: Stereotactic radiotherapy for localized low-grade gliomas in children: final results of a prospective trial. Int J Radiat Oncol Biol Phys 61 (2): 374-9, 2005.  [PUBMED Abstract]
   
   
8. Ruggiero A, Cefalo G, Garré ML, et al.: Phase II trial of temozolomide in children with recurrent high-grade glioma. J Neurooncol 77 (1): 89-94, 2006.  [PUBMED Abstract]
   
   
9. Finlay JL, Goldman S, Wong MC, et al.: Pilot study of high-dose thiotepa and etoposide with autologous bone marrow rescue in children and young adults with recurrent CNS tumors. The Children's Cancer Group. J Clin Oncol 14 (9): 2495-503, 1996.  [PUBMED Abstract]
   
   
10. McCowage GB, Friedman HS, Moghrabi A, et al.: Activity of high-dose cyclophosphamide in the treatment of childhood malignant gliomas. Med Pediatr Oncol 30 (2): 75-80, 1998.  [PUBMED Abstract]
    
    

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